Meeting Targets and Maintaining Epidemic Control (EpiC) Project - Cooperative Agreement No. 7200AA19CA00002
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Meeting Targets and Maintaining Epidemic Control (EpiC) Project Cooperative Agreement No. 7200AA19CA00002 CAMBODIA SEMI-ANNUAL PROGRESS REPORT OCTOBER 1, 2020 TO MARCH 31, 2021 SUBMITTED BY FHI 360: MAY 20, 2021
EpiC Cambodia Semi-Annual Progress Report
October 1, 2020 to March 31, 2021
A. EXECUTIVE SUMMARY
EpiC Cambodia provides technical assistance (TA) to the National Center for HIV/AIDS, Dermatology and
STD (NCHADS); to the eight focus provinces (Banteay Meanchey, Battambang, Kampong Cham, Kampong
Speu, Kandal, Phnom Penh, Preah Sihanouk, and Siem Reap); and to Global Fund (GF) implementers to
adopt new strategies to address the remaining gaps in the HIV cascade that have kept epidemic control
out of reach among key populations (KPs). The priorities for this year have focused on policy & public
health systems support, prevention, case finding, community-led monitoring (CLM), and strengthening
civil society organization (CSO)-led service delivery by capacitating CSOs to become self-sustaining social
enterprises.
During this reporting period, EpiC expanded its geographic footprint to Kampong Cham and Kampong
Speu Provinces. Meetings with Provincial Health Departments (PHDs) and Provincial AIDS and STI
Programs (PASPs) were conducted to introduce the EpiC project and Action Plan for Fiscal Year 2021
(FY21). Letters of Agreement (LoAs) for the two provinces were drafted and signed.
HIV testing to achieve the first 90 has faced challenges challenged relating to COVID-19, with shifts from
face to face activities to online approaches. Virtual outreach had the highest yield of HIV+ cases followed
by Peer-Driven Intervention (PDI+) and mobile van testing. HIV self-testing (HIVST) contributed
significantly to the detection of new cases. The yield of HIV testing among KP increased in quarter 2 and
the linked to treatment was high (see Figure 1). New pre-exposure prophylaxis (PrEP) sites were
established and PrEP initiations for those at high-risk continue to increase. NCHADS, community-based
organization (CBO), and clinic staff contribute to the second 90 by ensuring HIV positive cases are enrolled
immediately with same day antiretroviral therapy (ART) initiation (SDART), expanding multi-month
dispensing (MMD) of antiretroviral drugs (ARV), and continuing to support ART patients to access services
even with COVID-19 restrictions using motivational counseling (MC) skills and follow-up and support
through phone and SMS. Tracking the third 90 has been made more difficult due to COVID-19 and the
imposition of travel restrictions, creating fewer opportunities to test viral loads (VLs). A national patient
satisfaction feedback (PSF) standard operating procedure (SOP) has been developed and approval from
NCHADS is pending; PSF dashboards have been updated and are ready for use by ART sites. A new
conceptual design for CLM - known as the ‘KP feedback loop’ was developed and agreed to by
stakeholders. Desk review of Chhouk Sar Association’s (CSA) current service delivery model was
conducted, and concept note for a market survey developed.
EpiC Cambodia Semi-Annual Report (FY21 Q1-Q2 October 2020 to March 2021) 1
Figure 1: Key Population HIV cascade in 19 provinces, Q1 FY21 & Q2 FY21
B. KEY RESULTS BY OBJECTIVE
1. Policy & Public Health Systems Support
1.1 Strategic Information (SI) Leadership, governance, and granular data use for decision making
TA on prevention data for decision making
The Epic SI team worked closely with NCHADS Data Management Unit (DMU) and Behavior Change
Communication (BCC) team to manage and improve the National Prevention Database (NPD). With TA
from EpiC, the NPD has been updated to capture key prevention and testing indicators. The updates
include HIV self-testing data elements and indicators; generating Universal Unique Identifier Codes
(UUICs) for people who inject drugs (PWID); and results of recency testing. The NCHADS DMU team has
greater ownership and leads data from non-governmental organization (NGO) partners, ensuring data
quality, aggregation, and analysis, visualization, and presentation of data.
Key technical documents and tools were co-developed by EpiC and NCHADS based on granular data
analysis of the prevention cascade by modality in the context of the COVID-19 community outbreak
including:
• Social media tracking tool to capture the efforts from all partners on reaching and testing KP
virtually. Scaling up the virtual modality to reach and testing KP is an important focus area of the
NCHADS and NGO partners.
• Geographic information system (GIS) mapping tool updated in consultation with NGO partners
and built on the District Health Information Software 2 (DHIS2) platform.
• Standard prevention PowerPoint template that provides a visualization of the prevention and
testing cascade to be used by all NGOs partners.
EpiC and the NCHADS DMU and BCC team conducted joint field monitoring visits to four provinces,
Kampong Speu, Preah Sihanouk, Kampong Cham, and Tbong Khum, to support PASP and NGO partners
implementing prevention interventions at the field level and ensure compliance with national guidance;
to ensure field teams correctly understand prevention interventions including outreach, PDI+, virtual
outreach, and HIVST; and to clarify data collection for prevention indicators.
EpiC Cambodia Semi-Annual Report (FY21 Q1-Q2 October 2020 to March 2021) 2
EpiC not only provides TA to NCHADS, but also to GF sub-sub-implmenters (SSIs), the Reproductive Health
Association of Cambodia (RHAC), Khmer HIV/AIDS NGO Alliance (KHANA), and Friends International on
the DHIS2 system for KP data capture to make sure KP data can be uploaded to the NPD.
TA on care and treatment data for decision making
To support NCHADS on use of data for decision making, EpiC provided TA to the technical bureau and
DMU to conduct data quality audits in two ART sites (Preah Sihanuk and Ratanak Kiri), performed data
verification and cleaning, performed data analysis and visualization of the care and treatment data to
inform program improvement, and provided technical guidance based on the data to the ART sites and to
the PASP. Based on the results of the data analysis, NCHADS identified sites that have low rates of (MMD,
SDART, and tenofovir disoproxil, lamivudine, dolutegravir (TLD) transition and developed plans to provides
support to those sites to help them improve the service delivery.
Additionally, EpiC supported NCHADS and the United States Centers for Disease Control and Prevention
(US CDC) in finalizing the re-engagement SOP by updating the reporting tool and programming the
automated analysis of the patients with missed appointment dates.
The EpiC team also provided TA to NCHADS DMU and US CDC to develop a detailed data analysis
framework for national HIV treatment and President's Emergency Plan For AIDS Relief (PEPFAR) indicators
to ensure everyone is using the same definitions, the same method of calculation, and the same strategy
for interpreting data.
Actively support 2021 Asia Epidemic Modeling (AEM) exercise
• Worked closely with UNAIDS to support NCHADS to verify, organize, and extract detailed data on
HIV prevention; testing; enrollment and initiating care; lost-to-follow up (LTFU); death rate; and,
VL in order to include the most complete program data for the HIV estimation and projection in
the 2021 AEM exercise for Cambodian response. By the end of the reporting period, the Cambodia
2021 AEM report was finalized and sent to UNAIDS headquarters for final review.
• Actively participated in and contributed to the national elimination of mother-to-child
transmission (eMTCT) validation review co-led by NCHADS and the National Maternal and Child
Health Center (NMCHC) and facilitated by UNAIDS.
1.2 Work with US CDC to enhance the capacity of the NCHADS’s DMU and the SI Technical Working
Group (TWG) to review case-based surveillance (CBS) program data and other studies to better
understand emerging risks, vulnerabilities, co-infections and co-morbidities among key populations
and people living with HIV (PLHIV)
TA on the establishment of the Master Patient Index (MPI)
The consolidated HIV CBS and master patient index (MPI) system has moved forward with a revised MPI
concept diagram (Figure 2).
• Facilitation of a meeting with key stakeholders to have consensus on the revised MPI concept,
way forward and expected outcomes
• Established MPI technical team (DMU-NCHADS, EpiC, and HISP Vietnam) and held regular bi-
weekly meetings
• Developed HIV program indicator framework for the entire HIV cascade from prevention to VL
suppression.
EpiC Cambodia Semi-Annual Report (FY21 Q1-Q2 October 2020 to March 2021) 3
Figure 2: Diagram of the integrated database system of HIV in Cambodia – Master Patient Index
The MPI system utilizes data to drive timely, site-based HIV program improvement across the cascade
from prevention to VL suppression by integrating the prevention database (NPD); boosted integrated
active case management (BIACM) database; voluntary confidential counseling and testing (VCCT)
database; ART database; and the laboratory database into a single standard system using DHIS2 to
produce granular analyses based on agreed core HIV indicators for users at site, district, provincial, and
national levels.
EpiC provided TA to DMU to develop the HIV program indicator framework, shared a draft with
stakeholders for comments, and incorporated those comments in the final indicator framework. In late
March 2021, the MPI technical team conducted two meetings to discuss technical details of MPI and go
through the indicator framework.
TA on integrated biological and behavioral survey (IBBS) among female entertainment workers (FEW)
EpiC worked closely with UNAIDS Cambodia to provide TA to the NCHADS Surveillance Unit on the design
and implementation of the integrated biological and behavioral survey (IBBS) among FEW in Cambodia.
The COVID-19 pandemic negatively impacted and continues to impact the IBBS process. The NCHADS
Surveillance Unit has reviewed and revisited the study protocol and questionnaire; resubmitted to the
National Ethical Committee for Health Research (NECHR) of the Ministry of Health (MOH); programed all
survey instruments in ODK; tested and trained the NCHADS Surveillance Unit team members responsible
for IBBS; and distributed first round tokens in Kampong Cham and Mondul Kiri provinces, supported by
ongoing TA from EpiC team. EpiC also facilitated the approval from the GF to add presumptive sexually
transmitted infection (STI) treatment for the IBBS participants.
2. Client-Centered Services: Community-based Treatment Support, and Stigma and
Discrimination
With TA from EpiC, NCHADS:
• Increased SDART from 56% in Q3 FY20 to 69.5% in Q2 FY21.
EpiC Cambodia Semi-Annual Report (FY21 Q1-Q2 October 2020 to March 2021) 4
• Scaled up multi-month dispensing from 42.3% in Q3 FY20 to 50.5% in Q2 FY21.Increased
prescription of TLD for new ART patients from 72.3% in Q2 FY 20 to 89.7% in Q2 FY21.
• Achieved VL suppression for more than 90% of ART clients at the end of Q2 FY21.
Figure 3: HIV care and treatment cascade, Q1 FY21 & Q2 FY21
2.1 Improve quality and effectiveness of client-centered retention and return to treatment strategies,
such as Community Action Approach (CAA), SDART, undetectable = untransmittable (U=U), MMD,
and TLD transition
TA on Care and Treatment (MMD, TLD, SDART, VL, and enhanced adherence counselling [EAC])
The EpiC team has actively collaborated with the NCHADS AIDS Care Unit (ACU) to provide TA to improve
the quality of care and treatment, improve retention in care, improve VL suppression, and reduce LTFU.
• Routinely participated in meetings with the 3rd line ARV TWG)of NCHADS (national ART mentors)
to screen second line ART patients suspected of treatment failure and requested genotyping at
the Institute Pasteur of Cambodia (IPC). When appropriate, patients were switched to 3rd line
ARVs. In total there were 68 ART patients switched from 2nd line to 3rd line ARVs in the country.
• Actively participated in revising the National HIV Clinical Management Guidelines for Adults,
Adolescents and Children (5th revision) assisting the NCHADS’ consultant. The adult and children’s
guidelines were approved by MOH on 20 October 2020 and 3 December 2020, respectively.
• Provided TA to NCHADS and partners (US CDC, Clinton Health Access Intiative [CHAI], AIDS
Healthcare Foundation [AHF] and Catholic Relief Services [CRS]) to develop the national HIV
clinical management training curricula for adults, adolescents, and children. All curricula have
been finalized and submitted to the NCHADS director for approval.
• Co-facilitated with NCHADS ACU three dissemination and orientation workshops on the new
national HIV clinical management guidelines for adults, adolescents, and children to PHDs, PASPs,
and ART team leaders in Phnom Penh and provinces.
• Provided TA to NCHADS and US CDC to develop a supportive supervision of ART clinics SOP which
was subsequently approved by NCHADS Director.
EpiC Cambodia Semi-Annual Report (FY21 Q1-Q2 October 2020 to March 2021) 5
• Provided TA to NCHADS to develop the SOP for clinical mentoring to improve the quality of care
and treatment mainly SDART, MMD, EAC) VL test performance, and TLD transition. It was
approved by MOH on 20 October 2020.
• Provided TA to NCHADS, US CDC, and CRS to develop the SOP for tracing and re-engaging the LTFU
ART patients. The SOP was approved by the NCHADS Director on 15 March 2021.
• Provided TA to NCHADS and US CDC team to develop the strategic plan and the three-year (2021-
2023) roadmap for HIV care and treatment in PEPFAR supported sites. It was focused on the
following five core strategies: 1) building and sustaining clinical capacity; 2) sustaining retention
in care; 3) ensuring high quality of HIV care and treatment; 4) increasing demand and access to
quality of VL tests; and 5) improving Tuberculosis Preventive Treatment (TPT) implementation.
• Facilitated two training courses on oppostunistic infection (OI) and ART management to new ART
clinicians from different ART sites and a refresher training on MMD, TLD transition, and U=U to
PASPs, ART clinicians ,and ART counselors in Siem Reap Province and Kampong Chhnang Province.
• Facilitated quarterly meetings to review the VL, TLD transition, and SDART implementation issues
and outcomes with ART teams conducted by Phnom Penh Municipal Health Department (MHD).
• Supported two new integrated ART sites in Kampong Tralach Operational District (OD), Kampong
Chhnang Province and Batheay OD, Kampong Cham Province.
• Facilitated the transfer patients from ART sites in Kampong Chhnang and Kampong Speu to new
sites and provided coaching on new patient enrollment, SDART, and MMD.
• Worked closely with NCHADS managing the transfer of 6,000 patients from Khmer Soviet Hospital
ART and Social Health Clinic ART to NCHADS clinic and developed promotional materials to inform
patients.
• Regional Technical Officers (RTOs) supported PHDs, PASP) and ART team leaders on MMD, TLD
transition, SDART, VL, and EAC at regular Group of Champions (GOC) and Continuous Quality
Improvement (CQI) meetings.
TA on U=U rollout
U=U is a relatively new message in Cambodia for PHDs, PASPs, ART clinicians, nurses, counselors, and
members of the community. Some are hesitant or do not understand or believe the messaging. U=U can
reduce stigma and discrimination and encourage PLHIV to adhere to ARVs achieving VL suppression to
stop HIV transmission to sexual partners.
• Developed a slide presentation on U=U for use in all NCHADS trainings.
• Assisted NCHADS to develop a national U=U logo for Cambodia.
• Conducted field mentoring on PSF and U=U campaign to health care workers and PLHIV at
Kampong Cham Referral Provincial Hospital and Kampong Speu Referral Provincial Hospital.
• Supported the National AIDS Authority (NAA) to upload U=U testimony video
http://naaa.gov.kh/sb/28/9/1561 for its website and Facebook page to celebrate World AIDS Day.
• U=U video developed by EpiC was revised and uploaded on NCHADS AIDS Care Unit YouTube
channel: https://www.youtube.com/watch?v=_tgdpAyPvAE.
• U=U was promoted by EpiC in a web series campaign entitled “Risky Love” with PLHIV playing a
main role as peer educator who reached U=U status. : https://youtu.be/bA_hiTr5_j4 and
https://youtu.be/gEJvQNhXGYE.
EpiC Cambodia Semi-Annual Report (FY21 Q1-Q2 October 2020 to March 2021) 6
2.2 Promote friendly services to reduce stigma and discrimination for increase access to and uptake of
HIV prevention and treatment services among KPs
• Conducted a three-day training with CRS and MCHADS on MC that included 24 providers working
at 12 ART sites plus PASP managers/officers from four provinces.
• Joined monitoring visits with CRS and PASP to five ART facilities in Kampong Cham Province to
provide coaching on MC and use of those skills to engage clients in partner notification, bringing
partners for HIV testing, improving ART adherence, and reducing LTFU.
• Introduced MC into index testing and HIV Testing Service (HTS) trainings to guide PLHIV toward
identifying and referring partners and children for testing and as an adherence tool to guide PLHIV
to plan and achieve their treatment goals.
3. Prevention, Case Finding, and Policy & Public Health Systems Support
3.1 Scale up PrEP services for young and high-risk priority population to all HIV high burden areas
TA on PrEP
• Supported NCHADS to expand to new PrEP sites in Phnom Penh at the Toul Kork HC and the
NCHADS ART Clinic and FHC Battambang. The seven PrEP sites1 were able enroll 255 new clients
in FY21-Q1 and 308 new clients in FY21-Q2.
• Developed plan to integrate PrEP services at Maries Stopes International Cambodia (MSIC) clinics
in Phnom Penh, Kandal Province, Battambang Province, and Siem Reap Province. NCHADS and
MSIC have signed the LoA, but the training and launch have been delayed due to COVID-19.
• Conducted three PrEP launches in three different sites,four trainings (face to face and virtual),
and five onsite coaching sessions.
• Organized meetings with PrEP health providers and outreach workers (OWs), CBO, and KP
networks in each province launching PrEP services.
• Provided virtual orientation meeting on PrEP to NGOs (KHANA, RHAC, Men's Health Center [MHC],
Men's Health Social Service [MHSS], Cambodian Women for Peace and Development [CWPD],
Friends-International [FI], and Marie Stopes International, Cambodia [MSI-C] staffs) and outreach
workers.
• Joined virtual monthly and quarterly meetings with OWs, CBO, and NGO networks to share PrEP
information and discuss the challenges regarding to PrEP access and how to improve KP
participation.
• Reviewed and revised PrEP forms, including registration form and report forms, to be more
practical, shorter, and simpler for implementation and all were approved by the NCHADS director.
• Provided regular virtual technical monitoring and support to PrEP sites focused on operations,
challenges, and drug supply and assisted NCHADS and PHD, OD, and RH to renew contracts with
all family health clinics for PrEP lab test and fee reimbursement.
1
Seven PrEP sites include Phnom Penh 5 sites: Chhouk Sar Clinic, Family Health Clinic (FHC) of Pochentong RH,
Samdach Ov- Samdach Me RH, Touk Kork HC, and NCHADS ART Clinic; Banteay Meanchey Province 2 sites: in FHC
Serey Sophorn RH and FHC Poi Pet RH; Siem Reap province 2 sites: in FHC Siem Reap Provincial Hospital and RHAC
Clinic; and Battambang Province 1 site: FHC at Battambang Referral Hospital.
EpiC Cambodia Semi-Annual Report (FY21 Q1-Q2 October 2020 to March 2021) 7
Figure 4 shows increasing number of KP newly initiating PrEP in Q1 and Q2 FY21. The majority (80%) are
men who have sex with men (MSM); 14% are transgender women (TGW); and 6% are FEW or KP partners.
Figure 4: PrEP coverage in 4 provinces of Cambodia
• Based on UNAIDS recommendations, EpiC has drafted a SOP for PrEP implementation by facility
and community-based organizations and submitted for review.
3.2 Address gaps in case findings for priority and general population through refining testing modalities
such as social networking (PDI+), index case testing (ICT), and HIVST with the increased use of social
media
TA on the Boosted Continuum of Prevention to Care and Treatment (B-CoPCT) SOP Revision
• Assisted NCHADS BCC unit to revise Boosted Continuum of Prevention to Care and Treatment (B-
CoPCT) SOP for all KPs including PWID. B-CoPCT aims to reach the unreachedand hard-to-reach
KPs by improving targeting, relevance, and frequency of services delivered, as well as its
efficiencies.
• Participated in boosted CoPCT quarterly meetings and assisted BCC/Prevention team conducting
pre-meetings in schedule, agenda, and slide desk preparation as well as p[roducing meeting
reports.
• Joined monitoring visits with NCHADS BCC/Prevention unit to Kampong Cham and Tbong Khmum
Province that focused on HIV prevention along with the HIV cascade, testing modalities,the key
challenges with outreach activities during COVID-19 pandemic, and quality data verification at
each site. The monitoring team also provided onsite training on promotional materials, social
media outreach, PDI+ visualization, the PrEP service pathway. U=U messaging,and OWs and staffs.
• Worked with the Department of Mental Health and Substance Abuse (DHMSA) to review and
finalize the SOP on overdose prevention and management for people who use drugs and to revise
the operational guidelines for the needle and syringe program to support NGO partners and KP
members who are working to reduce the spread of blood borne viral infections such as HIV and
hepatitis C among PWID.
EpiC Cambodia Semi-Annual Report (FY21 Q1-Q2 October 2020 to March 2021) 8
TA on Peer Driven Initiative (PDI+)
•PDI+ is an incentive-based, peer-centered, risk-tracing snowball approach where seeds recruit
peers within their networks via physical and virtual contact and promote risk screening and HIV
testing services. The EpiC Technical Advisor has worked closely with NCHADS and implementing
partners to provide technical support to strengthen PDI+ implementation through onsite
coaching. During the reporting period 911 MSM, 231 TG, and 78 FEW recruited through PDI+ were
tested for HIV and 3.5% of MSM and 7.8% of TG were found positive and all positives were
enrolled in ART services. (Figure 9)
TA on HIVST
• Provided TA to the NCHADS VCCT Unit as they organized a one-day HIVST orientation to (1) create
demand for existing HIV testing services; (2) reach as-yet undiagnosed KPs, and (3) build
collaboration to strengthen referral linkages.
• Assisted the NCHADS VCCT unit to train KP focused community-based organizations on HIVST,
testing procedures, specimen collection (oral fluid), interpretation of results, and conducting pre-
test and post-test counseling using MC skills. Additionally, assisted in training on ensuring linkage
of reactive cases to confirmatory testing and enrollment in ART services.
• Assisted NCHADS in purchasing 2,000 HIVST kits with UNAIDS funding.
• Provided TA to NCHADS as they developed guidance for incorporating HIVST in index case partner
testing.
• HIVST implementation began at the end of the first quarter. To date, 699 KP self-tested with 11.6%
of MSM, 6.2% of FEW, and 12.4% of TGW found positive – rates much higher than conventional
face -to-face testing. (Figure 5)
Figure 5: HIVST Cascade December2 2020 – March 2021, by KP
800 14.0%
699 12.4%
700 11.6%
11.2% 12.0%
600
10.0%
500
422 8.0%
400 6.2%
6.0%
300
202 4.0%
200
100 78 78 65 2.0%
49 49
25 25 10 0.0%
4 4 0 0
0 0.0%
Total FEW MSM TG PWID
Tested for HIV Tested HIV+ Newly initiated ART % of positive
2
HIVST started the implementation phase in December 2020, which is why there is no data from October 2020.
EpiC Cambodia Semi-Annual Report (FY21 Q1-Q2 October 2020 to March 2021) 9TA on Partner Notification Tracing and Testing (PNTT)
• Worked actively with NCHADS TWG and partners to revise PNTT training curriculum to respond
to RedCap survey results.
• EpiC contributed to revise PNTT training curriculum to include MC, Gender Based Violence
(GBV)/Intimate Partner Violence (IPV), LIVES, PNTT adverse event, and U=U. Participated in
NCHADS TWG and worked with partners to develop PNTT mentoring checklist for
• Improving the quality of PNTT implementation by CAA at ART sites.
• Participated a key member of a small working group tasked with developing PNTT job aids (PNTT
tools/flipchart). The PNTT job aid was finalized and submitted to NCHADS senior management
team for approval.
• Worked closely with the NCHADS DMU and partners to revise PNTT patient record (A2) and
quarterly report form to align with new revised PNTT training curriculum. The NCHADS’ ART
database is being updated based on the revised A2 form. EpiC SI team provided TA to DMU to
update the Excel spreadsheet based on the revised A2 form to be used as temporary data
collection.
• Facilitated quarterly meetings reviewing PNTT implementation and outcomes. EpiC reviewed the
PNTT SOP developed by Phnom Penh Municipal Health Department (MHD) for all ART sites in
Phnom Penh.
• Provided TA to DMU to collect, aggregate, analyze, and produce PNTT quarterly reports. Based on
the NCHADS PNTT data in Figure 6, PNTT has the highest yield of any intervention in finding new
HIV cases (30%) among partners of index HIV cases. EpiC is working with CRS to increase
participation to 80%, doubling the numerical yield.
Figure 6: Partner Notification Tracing and Testing result – FY21-Q1&Q2
2000 98% Offered
1800 Index Testing
1600
1400
1200
1000 41% Accepted 1:02: Contact
800 1745 1708 Index Testing elicitation rate 30%
600 Positivity Rate
400 151
702 715
200 351
0
Index registered Index offered Index accepted Index contacts Partner tested for HIV
Index registered Offered Accepted Partner Tested Negative Tested Positive
Source: NCHADS PNTT Data
TA to Improve Online Outreach
During the COVID-19 pandemic, EpiC technical team has built capacity for SSSIs in both the Southern and
Northern Zones to better provide information on PrEP, HIVST, and MC through online trainings. Over 200
outreach workers and field staff participated. Outreach workers requested that EpiC organize quarterly
refresher trainings including new topics related to online outreach and tracking tools. EpiC supported
EpiC Cambodia Semi-Annual Report (FY21 Q1-Q2 October 2020 to March 2021) 10NCHADS to organize a series of meeting to develop training plans and promotional materials based on the
SSSI needs.
Online Reservation Application (ORA)-TOHTEST
The TohTest online self-assessment and reservation app has been implemented in Phnom Penh and linked
to the Chhouk Sar Clinic. ORA actively engages client in HIV prevention through their own self-assessments
and offers online booking for appointments with clinic staff for HIV counseling and testing
(https://tohtest.org). During the reporting period, 158 appointments were made through TohTest; 89
arrived at the clinic (56% of total appointments); 80 clients were tested for HIV; and 4 (5%) clients were
found HIV positive and initiated on ART (Figure 7).
Figure 7: Result of TohTest from October 2020 – March 2021
160
140
120 5% passivity
100 rate
4 11
80 158
60
40 89
76 69
20 4 39
11 20
0
Total Booking Arrived at HIV Tests Linked to HIV STI Tests Linked to STI PrEP offered PreP Initiated
clinic Treatment Treatment
Tested HIV - Tested HIV + STI NR STI R
NATIONAL LEVEL PREVENTION PROGRAM RESULTS
Below are key achievements of the national prevention program for Q1 and Q2 FY21. KP testing and
seropositivity rates and ART initiation by quarter are seen in Figure 8 and the HIV case finding rate by
testing modality in Figure 9. First VL tests are performed at six months treatment and therefore, none of
the clients who initated treatment during the past semester are eligible. TGW have the higher case finding
rate in both Q1 and Q2 (4.2% and 3.9%, respectively), followed by MSM (1.9% and 2%, respectively). Figure
9 demonstrates that virtual outreach is the most effective modality in finding new cases of HIV among
MSM, TG, and FEW (>10%), and PDI+ and mobile van testing at nighttime are also effective in new case
finding among TG and MSM. All positive cases enrolled in ART except for 2 pending KP (MSM and FEW)
enrollment due to lock down situation.
EpiC Cambodia Semi-Annual Report (FY21 Q1-Q2 October 2020 to March 2021) 11Figure 8: Uptake of HIV testing and treatment among KP (October 2020 – March 2021)
17,568
19,417
23,163
32,663
16,249
11,474
100,000 4.5%
9,110
7,739
4.2%
4,820
3,928
3.9% 4.0%
2,390
1,774
10,000 3.5%
702
681
3.0%
1,000
228
227
187
171
171
156
2.5%
94
94
75
75
58
57
1.9% 2.0% 2.0%
100
23
23
1.5%
10 1.0%
0.7%
0.5%
1 0.1% 0.0% 0.0% 0.0%
FY21-Q1 FY21-Q2 FY21-Q1 FY21-Q2 FY21-Q1 FY21-Q2 FY21-Q1 FY21-Q2
FEW MSM TG PWID
Reached Tested for HIV Tested HIV+ Newly initiated ART % of positive
Source: National Prevention Database (NPD) – 19 provinces
Figure 9: HIV positivity rate by modality, by KP (October 2020 – March 2021)
100000 14.0%
22821 18197
12.5% 12.3% 12.0%
10000 11.4%
3612
10.0%
1065 911 9.5%
684 798
1000
8.0%
273 231 7.8%199
117 122
73 78 78 6.0%
100
24 32
16 15 18 19
4.0%
3.5% 3.2%
10 5
3 2.0% 2.0%
1.5%
0.3% 0.5%
1 0.0% 0.0%
Physical Virtual PDI+ Mobile Physical Virtual PDI+ Mobile Physical Virtual PDI+ Mobile
outreach outreach Van outreach outreach Van outreach outreach Van
FEW MSM TG
Test for HIV Tested HIV + % of positive
Source: National Prevention Database (NPD) – 19 provinces
TA on Social and behavior change communication (SBCC) and Social Media
EpiC developed online and social media tools to promote demand for PrEP, HIVST, TohTest, and other
interventions. Tools included:
• PrEP video for online trainings and graphic image postings.
• Kapea Klounnak, a video web series and social media influencer campaign that promoted PrEP on
NCHADS’s Facebook page and Facebook pages of NGO partners such as MStyle Khmer,
SMARTGirl, Sreysros Khmer, MET Laor Page, Men’s Health Cambodia and CWPD. A Telegram
group for CSOs and providers to communicate and exchange information related to PrEP
implementation.
EpiC Cambodia Semi-Annual Report (FY21 Q1-Q2 October 2020 to March 2021) 12• Various creative social media campaigns implemented by the SBCC team – most recently
Valentine's Day Campaign 'Love Deeper, Love Safer'. The objectives were to promote safe sex and
condom use among young adults by making the hashtag #lovedeeper trend on social media on
Valentine’s Day, creating buzz and engaging young audiences to participate in a narrative about
safe sex. A series of photoshoots and two videos were produced and published on NCHADS’s
Facebook page as well as on the artists’ own Facebook and Instagram pages. As a result of the
Valentine’s campaign, we saw almost immediate engagement: social media users posted on
Facebook and Instagram using our hashtags #lovedeeper and #ME2U, put our campaign frame on
their profiles, and re-posted and shared posts from our artists. Link to promo video:
https://fb.watch/5fi7svmXpR/ NCHADS Facebook page: https://www.facebook.com/kapeakh
• 634,820 individuals were reached (defined as seeing a PrEP promotion post at least once);
148,588 watched videos promoting PrEP; and 20 clients initiated PrEP through TohTest in the
beginning of September 2020 at Chhouk Sar Clinic.
4. Community-led Monitoring (Regional Operational Planning [ROP] 20 Technical Priority):
Support national and sub-national KP monitoring tools and quality assurance
4.1 Scale up the implementation of “Patient Satisfaction Feedback” (PSF) system to be used as an S&D
monitoring platform.
TA on Patient Satisfaction Feedback System (PSF)
PSF system provides (Figure 10) patient feedback to ART sites to drive quality improvement toward
increasing satisfaction, improving patient outcomes, and reducing the treatment interruptions among
PLHIV. With TA from EpiC and NCHADS, CRS reported the following results:
• NCHADS and CRS scaled up the PSF to 51 ART sites across the country.
• Conducted two training courses on the PSF to 44 healthcare providers from 21 provinces.
• Conducted joint technical monitoring visit for PSF implementation to Kampong Cham and
Kampong Spue. NCHADS discussed a recommended action plan to improve service quality and
covered other topics including U=U for providers and adherence counseling for patients with
detectable viral loads to strengthen ART adherence.
• Revised the PSF SOP and produced a comprehensive final draft which was submitted to NCHADS
for final review and approval.
EpiC Cambodia Semi-Annual Report (FY21 Q1-Q2 October 2020 to March 2021) 13Figure 10: PSF implementation procedure at ART site
• Improved the PSF dashboard and produced a complete set of data vizualizations for both patients
and providers ready for launch and use to drive quality improvement
• Integrated four core PSF indicators into the revised CQI SOP3: 1) % of clients reporting satisfied
with service they received; 2) % of clients reporting the waiting time is acceptable; 3) % of clients
receiving adequate counseling; and 4) % of providers rated their health facility’s services for KPs
as high quality.
• Planned, in partnership with NCHADS, a Health4All step-down training during the first quarter of
2020 for health provider staffs in hospitals and health centers. However, the training was delayed
due to the COVID-19 pandemic. Therefore, NCHADS will reschedule to hold the Health4All training
online in Quarter 3 of 2021.
4.2 To foster real KP and PLHIV community participation and monitoring across the entire prevention
to care cascade, EpiC will work with Joint Forum of Networks of PLHIV and Most-At-Risk Populations
(MARPs or KPs) FoNPAM nationally and DFoNPAMs in the Districts
Community feedback loop
EpiC and UNAIDS Cambodia have provided TA to Health Action Coordinating Committee (HACC), a
network of civil society organizations working on health in Cambodia, KP Community Network, Forum of
Networks of PLHIV and Most-At-Risk Populations (MARPs) (FoNPAM nationally and DFoNPAMs at Districts
level), and CBOs to facilitate and initiate the development of community feedback loop. Several
consultative meetings were held with a small core group and key stakeholders to collect further inputs
and to find out the convenient platform to collect community feedback and generate findings. . FoNPAM
and DFoNPAM. Will be usedto communicate within eleven local fora at the operational district, provincial,
and national level (see figure below on the process and flow of KP community feedback loop).
3
CQI SOP aimed at maintaining high quality of HIV program services across the continuum of care for PLHIV in
Cambodia
EpiC Cambodia Semi-Annual Report (FY21 Q1-Q2 October 2020 to March 2021) 14Figure 11: Diagram for KP community feedback loop
EpiC SI team will provide TA to HACC and FONPAM to establish the feedback loop’s online system and
community scorecard dashboard so that they can be used to seek support at both the sub-national and
national level for best benefit of their team in term of accessing HIV prevention, HIV testing, STI service,
social protection, gender-based violence, and reduce stigma and discrimination.
EpiC’s regional technical coordinators in Phnom Penh, Battambang, Banteay Meanchey, and Siem Reap
provinces assisted network representative (DFoNPAM) in data analysis and data-driven action through
the B-IACM GoC meeting to raise any issues that were encountered at the community level.
4.3 Work with NAA and NCHADS to scale up community GBV reporting and referral network for legal,
social, and medical supports for priority and general population experiencing GBV (includes IPV)
including prompt referral and access to post-exposure prophylaxis (PEP)
• FHI 360 (EpiC and Enhancing Quality of Healthcare Activity [EQHA] project), the Municipal Health
Department (MHD), and Municipal Consultative Committee for Women and Children (MCCWC)
obtained support letters from Phnom Penh Municipal Administration on Supporting Gender
Based Violence (GBV) and HIV Response Mechanism for Phnom Penh. EpiC and EQHA coordinated
with MHD and NCHADS to provide two trainings on GBV and HIV response for 59 health care
providers from emergency units, ART sites, referral hospital Family Health Clinics, and municipal
referral hospitals.
• NCHADS supported EpiC virtual training on raising awareness and responding to GBV for 52 peer,
field staff, and outreach worker representatives from KHANA and RHAC who participated in four
virtual sessions.
• EpiC ,in partnership with USCDC and other NGO partners, supported NCHADS revisions to the
PNTT training manual where IPV is a key topic in the communication materials. Several meetings
with the technical team have been conducted to review and discuss on those tools, which have
now been submitted to NCHADS management for review and approval.
EpiC Cambodia Semi-Annual Report (FY21 Q1-Q2 October 2020 to March 2021) 155. Strengthen CSO-led service delivery by capacitating CSOs to become social enterprises:
Social Enterprises
5.1 Develop social enterprise (business) models with CSA and other CSOs
Technical assistance to CSA and other CSOs to develop social enterprise models that strengthen CSO-
led HIV service delivery (ROP Funding)
EpiC’s global sub-partner Palladium recruited a local consultant to work closely with the EpiC and Chhouk
Sar team. The consultant initiated a global review of best practices on social enterprise models for HIV
service delivery and reviewed Chhouk Sar’s business model and financial situation. Activities included:
• Review of existing business models, strategic plans, and sustainability strategies used by CSA and
other CSOs.
• Creation of a shortlist of promising social enterprise models after several meetings with CSA
management, staff, and Board of Directors as well as EpiC team members. The models including
fee-based services, membership program, commission/referral fees and social contracting as
means to diversify and increase non-donor financed revenue. A dialogue and working group
session with CSA regarding shortlisted models were conducted.
• Development of a concept note for a market survey of key and general populations to identify
which additional services are most interesting to both existing and potential new clients and to
better understand their willingness to pay for the new clinical servicesand the clinical service
attributes that are important to patients in order to improve the future services.
5.2 Develop social enterprise models with local CBOs
MSI and the RHAC have successful social enterprise models that provide reproductive health and STI
services at affordable prices. They provide HIV screening and then refer positives to government and
private clinics for confirmatory testing and ART. Both either are providing or will provide PrEP services
with NCHADS and MOH support. There are no other CBO clinics offering similar services. Discussions and
models for cooperation with NCHADS to support ART in MSI and RHAC clinics are underway. If added, self-
sustaining, private, one-stop STI/ART care would be available in their clinics. There are still concerns about
government provision of medications to private not-for-profits, despite the Chhouk Sar and Sihanouk
Hospital Center of Hope examples. EpiC will continue the discussions.
EpiC senior management team has discussed with NCHADS director emulating the PrEP delivery model at
Service Workers in Group (SWING) in Bangkok, Thailand, at MHC, and at other CBOs in Cambodia. Dr. Frits
Van Griensvan, UNAIDS consultant, has recommended potential model using CBOs for PrEP delivery (MHC
in Phnom Penh will be the first CBO delivery of PrEP) to improve KPs access to PrEP service. NCHADS
management team agreed that the EpiC team draft the SOP on PrEP delivery by facility and CBO. The SOP
has been drafted and it is waiting comment by NCHADS management.
C. ADDITIONAL ACCOMPLISHMENTS TO HIGHLIGHT
Gender:
Cooperate with EQHA to integrate Gender and GBV in health sector:
• Engaged with EQHA to work with MoH Gender Mainstreaming Action Group (GMAG) team to give
technical inputs to develop a training curriculum on strengthening Gender Integration in health
sector. So far, this training curriculum has been translated into Khmer language in anticipation of
the consultative workshop.
• Engaged with EQHA to give inputs for advocacy to integrate Gender and GBV into MoH nursing
curriculum.
EpiC Cambodia Semi-Annual Report (FY21 Q1-Q2 October 2020 to March 2021) 16• Engaged with EQHA to give inputs on EQHA project’s Site Assessment on Gender-Based Violence
Service Response at Referral Hospitals to identify successes, gaps, and challenges in meeting
minimum standards in post-GBV health services and explore motivation and commitment of
health care workers toward meeting minimum standards. The assessment completed in January
2021.
GBV and HIV Integration EpiC Technical Advisor was also assigned as safeguarding focal point for FHI 360
and conducted online trainings for FHI 360 and NGO partner staff to build awareness and core knowledge
of safeguarding issues and the policies FHI 360 has in place to prevent and respond to harm towards
program participants. Sexual exploitation and abuse (SEA) and sexual harassment (SH), Safeguarding of
children, and Combating Trafficking in Persons (CTIP) were brought up and discussed with all participants
during the trainings. 80 FHI360 Cambodia staff completed the training.
D. MANAGEMENT AND OPERATIONS
• Sub-agreement with CRS was signed and implementation began in October 2020.
• The LoA with NCHADS, LoA with Provincial/Municipal Health Department of Banteay Meanchey,
Battambang, Siem Reap and Phnom Penh were signed. The expansion to include four other
provinces under EpiC Project is still in process.
• SI Senior Technical Advisor resigned and there was a one-month gap to fill the position.
• One RTO resigned and new replacement recruited to cover Kg Spue and SHV and will be aboard
in May 2021.
E. HUMAN SUBJECTS PROTECTION
N/A
F. ENVIRONMENTAL COMPLIANCE
• The EMMP was submitted to USAID in April 2021.
G. SUCCESS STORIES, VISUALS AND BEST PRACTICES
Prep Social Media Campaign
EpiC Cambodia Semi-Annual Report (FY21 Q1-Q2 October 2020 to March 2021) 17Felix Sea, in PrEP photoshoot. Credit: Saren Chansreywatana - October 2020
Over the course of the campaign, 24 videos and 22 photos s on PrEP were posted, reaching the following
audience:
Social Media Reached View Likes Comments Shared
Facebook 679,513 187,779 5,504 256 1,117
Instagram 2,675 704 101 3 3
YouTube 39,926 4,081 123 14 -
Risky Love Campaign
From the left, San Mengleaang, Thy Vanniva, Sok Polin, and Chhit Sovannimith. Credit: Stuido4 – December 2020
Risky Love campaign officially rolled out for the entire month of December 2020 on popular social media
platforms and targeted high risk young population less than 30 years old.
The campaign published 116 posts, both videos and photos on Facebook, YouTube, and Instagram and
TikTok, and reached the following audiences.
Referred
Tested for Tested Tested Initiated
Reached View Likes Shared to online
HIV & STI HIV+ ST+ PrEP
booking
2,86,528 1,297,062 60,751 4,614 696 29 2 7 6
EpiC Cambodia Semi-Annual Report (FY21 Q1-Q2 October 2020 to March 2021) 18‘No means No’ - Women Rights Day Video Promo Vinich Virak (director), Vy Kimleng (female cast), and Mat Oulary (male cast) – March 2021. Credit: Maly Phou. This video was created to re-enforce message that all women have the rights to protect themselves from HIV, STIs, and accidental pregnancy. We cast CWPD staff for the video to engage our NGO partners in the promotion work and to spread key messages to their network and peers. Link to video https://fb.watch/5fjO8qucm8/ Virtual Capacity Building - ‘PrEP Training Video Shooting’ Mr. Vannak Keo – March 16, 2021. Credit: Vinich Virak SBCC initiative to create online training curriculum and materials for outreach workers and partners to assist capacity building during COVID-19 and beyond. EpiC Cambodia Semi-Annual Report (FY21 Q1-Q2 October 2020 to March 2021) 19
Best Practices
• The NPD using DHIS2 to track the progress of the prevention intervention program among key
population, developed and managed by NCHADS with TA from EpiC, was recognized as the best
database capable of producing KP prevention cascade that NCHADS and stakeholders using to
improve program implementation.
• Engage partners, network of influencers, and friends in promotional campaign to maximize effect
of behavioral change communications.
• Utilize internal resources in production (photoshoot, filming, props etc.) to save costs, increase
content, and enhance creativity.
• Identify the right social influencers based on their aspiration and knowledge, rather than just the
number of followers.
• Research and adapt creativity and digital marketing strategy in content, design, and ideas to reach
and engage young KPs and build strong branding.
• Collaborate with youth leaders, creative individuals, and experts to seek new ideas and initiatives.
• Listen to audience testing, feedback, and recommendation for improvement and innovation.
H. MEDIA COVERAGE, TOOLS AND PUBLICATIONS
Press Release – PrEP Launching event organized by NCHADS with technical support from EpiC
Cambodia
https://www.postkhmer.com/ជី វ ិតកម្សាន្ត /សិក្ខាសាលាសដ ីពីក្ខរប្រក្ខសដាក់ឱ្យអន្ុវតត វ ិធីលេរថ្នរ
ាំ ង្ការជាម្សុន្លៅ
កម្សពុជា
EpiC Cambodia Semi-Annual Report (FY21 Q1-Q2 October 2020 to March 2021) 20Press Release – 'Risky Love' mini-series launched organized by NCHADS with technical support
from EpiC Cambodia
https://dap-
business.com/event/2020/12/07/4073/?fbclid=Iw
AR1fEcYOWpGlahfRNgHWsFBzjpG5xfMRc_8WTV1
aHYxwuBGDw3ad-YZgauI
https://lookingtoday.com/event/2020/12/07/550
16/?fbclid=IwAR18V770zB2ORmPgFGdPwL2zKoCA
j3AUDq8pshG9OZL4KSne-E4l0U6rDUI
http://freshnewsasia.com/index.php/en/localnew
s/179016-2020-12-07-09-21-
58.html?fbclid=IwAR0g30ehUCNmOcCYIsJk_DQUu
N2f8Md6_fmFnWxA2Iewvfmss0F7uipwhXI
https://khmernews.news/article/archives/130506
?fbclid=IwAR0l7iCLq_xRZ7McxJjBiBRs013PNJwiTH
YCzm4fyimTyrYc0iyRfZ9CS0g
https://dap-
news.com/advertising/2020/12/07/103655/?fbcli
d=IwAR1HjvZC3rQ35GDhtQ-
AflWfPeLBvDkOET9sJT69SfeMUzrbbPbuAkcryJw
Promoting safe sex and condom use with Valentine’s Day social media campaign “Love Deeper Love
Safer”
https://epicproject.blog/2021/03/01/promoting-safe-sex-and-condom-use-with-valentines-day-social-
media-campaign-love-deeper-love-safer/
EpiC Cambodia Semi-Annual Report (FY21 Q1-Q2 October 2020 to March 2021) 21I. PRIORITY ACTIVITIES IN THE NEXT SIX MONTHS (APRIL TO SEPTEMBER 2021)
During the next six months in Cambodia, EpiC will:
• Conduct orientation and training on HIVST for other provinces.
• Conduct virtual trainings for MSIC service providers on HIVST and PrEP.
• Conduct knowledge, attitude and practiceKnowledge, Attitude, Practices (KAP) survey with young
MSM and TG.
• Finalize the concept note of the market survey and conduct the focus group discussion with KP
and general population.
• Consultation workshop with Chhouk Sar and key stakeholders to finalize the social enterprise
model.
• Finalize the PSF SOP and launch as well as provide orientation on the use of PSF dashboard.
• Conduct refresher trainings on Health4all and MC.
• Continue to support MPI technical team to move MPI work forward.
• Continue TA to NCHADS and SSI on the prevention database, GIS mapping update, and social
media data collection and reporting.
• Develop CLM database system and dashboard to monitor and support the community feedback
loop.
• Develop online learning and training curriculum and materials to support capacity building of
internal team, partners, and outreach workers moving forward to the new normal.
• Support PHD to coordinate Provincial Consultative Committee for Women and Children (PCCWC)
meetings to establish provincial GBV TWG and district GBV working groups that include KP reps
• Develop and maintain GBV Service Directory.
• Develop GBV demand generation among KP and women, including young girls, and media
connection to promote GBV and HIV responses.
• Provide orientation to members of provincial GBV TWG,
• Provide capacity building on GBV, IPV, KP, PEP, first line support, and reporting to health care
provider in provincial level plus targeted ART and Family Health Clinic sites to improve GBV
services response to KP and general populations.
• Continue supporting Prevention Unit of NCHADS to facilitate development of SOP, concept note,
guideline development, session plan and training curricula, including organizing the quarterly
meeting among SSI and relevant unit of NCHADS.
• Continue supporting DMHSA on SNP revision and further documents.
• Assist Prevention Unit of NCHADS to facilitate training to SSI on virtual outreach, messaging, and
tracking tool.
• Assist Prevention Unit of NCHADS to facilitate refresher training on PrEP, HTS, and MC to SSI and
its implementors.
• Collaboration with Prevention Unit of NCHADS to conduct monitoring visit to prevention
programs among KPs located in Southern, Northern Zones, AHF and FI.
• Continue participating on Bossted-Continuum of Prevention to Care and Treatment ( B-CoPCT)
and PNTT technical working group for training curriculum, tool, and promotional material
development.
• Assist CRS and AIDS care unit of NCHADS to organize MC among selected health care providers
and CAA team, including joining the monitoring visit of national HIV program (NCHADS), PASP,
and CRS to ART sites where have already trained.
EpiC Cambodia Semi-Annual Report (FY21 Q1-Q2 October 2020 to March 2021) 22Annex A: Performance Monitoring and Evaluation Matrix
Table 1: EpiC achievements of benchmark indicators
Indicators (PEPFAR & PEPFAR Result Total Annual % target Justification
Custom) support Q1 Q2 (YTD) target achieved
Type to date
Number of ART clinics TA 0 0 0 31 0.0% Off track. MPI real-time data not
able to do entry data at yet start implementing. It is still in
real-time (*) the designed phase by HISP VN.
The new contract between
NCHADS and HISP not yet sign.
Number of provinces able TA 19 19 19 25 76.0% On track. 19 province
to analyze and use data implementing prevention
for monitoring and intervention received training and
strategic planning ongoing TA support from EpiC to
purposes (*) perform data analysis.
Percentage of ART clinics TA 96% 100% 100% 100% 100.0% On track. New recruited CAA
with CAA provide active selected by GF partners already
identification of stable trained and be able to support ART
patients and routine ART team to provide ART services.
visits managed by
protocol (community or
facility) by CAA team or
lower cadre workers (*)
Percentage of PLHIV TA 49.02% 50.5% 50.5% 70% 72.2% On track. Reaching more than 50%
receiving MMD per of the annual target within two
national guidelines (from quarters
3 - 6 months)
Percentage of active ART TA 32.78% 34.35% 34.35% 35.00% 98.1% On track. Almost achieved the
patient receiving TLD (*) annual target.
Number of KP (and TA 269 380 649 820 79.1% On track. Almost achieved the
partners of KP) newly annual target.
diagnosed of HIV positive
(*)
Number of individuals TA 227 275 502 2244 22.4% Off track. Under 50% of the annual
who were identified and target. The ART providers offer to
tested using Index testing almost all new clients initiating
services and received ART during reporting period, but
their results the acceptant rate is less than
50%.
Yield of testing through TA 0.73% 1.41% 1.00% 1.30% 76.9% Somewhat on track. Hope to reach
optimized case finding target in the end of FY21.
modalities - outreach
Yield of testing through TA 4.26% 3.85% 4.10% 5.90% 69.5% Somewhat on track. Hope to reach
optimized case finding target in the end of FY22.
modalities - PDI+
Yield of testing through TA 10.38% 11.71% 11.20% 6.70% 167.2% On track. Based on the HIVST
optimized case finding program implementation, the yield
modalities - HIVST of HIVST is over target. Coverage is
still only in the Phnom Penh
municipality. Will scale up to
province in the next quarter.
Number of individuals TA 255 308 563 2600 21.7% Off track. Under 50% of the annual
who were newly enrolled target. Huge negative impact on
on oral antiretroviral pre- the PrEP enrollment due to
exposure prophylaxis ongoing COVID-19 community
(PrEP) to prevent HIV outbreak.
EpiC Cambodia Semi-Annual Report (FY21 Q1-Q2 October 2020 to March 2021) 23Indicators (PEPFAR & PEPFAR Result Total Annual % target Justification
Custom) support Q1 Q2 (YTD) target achieved
Type to date
infection in the reporting
period
Number of sites with PrEP TA 9 10 10 16 62.5% Somewhat on track. PrEP scale up
(*) also impacted by the COVID-19
community outbreak.
Percentage of patient TA 87% 82% 82% 75% 109.3% On track. Majority of client
satisfied with the service satisfied with ART services.
(using patient satisfaction
feedback)
GBV referral system for TA 1 1 1 4 25.0% Off track. There is another GBV
KPs expanded into 4 HIV support system in place with
high burden provinces (*) multi-stakeholders involved in
other provinces so there is lots of
coordination to be done to
integrate what EpiC plans to do in
those provinces.
Chhouk Sar (KP friendly)
Off track. The impact of COVID-19
clinic branding model
community outbreak really affects
developed and TA 0 0 0 3 0.0%
the decision of NCHADS to expand
implemented by Global
the model of CSC.
Fund (GF)
Note: (*) are cumulative indicator
EpiC Cambodia Semi-Annual Report (FY21 Q1-Q2 October 2020 to March 2021) 24Annex B: Impact of COVID-19 on Implementation
Significant negative impact on HIV response due to the COVID-19 outbreak beginning February 20th, 2021
• Impact on confirmatory testing, SDART, TLD, and VL testing – however, MMD has increased (Q2
data not yet ready).
• Some ART site staff had direct or indirect contact to COVID-19 positive case that required
quarantine and self-isolation.
• Chhouk Sar Clinic staff were quarantined at the clinic. ART and PrEP for enrolled clients has
continued during and after quarantine, but HIV confirmatory testing, ART and PrEP initiation, and
VL testing have stopped. Chhouk Sar staff await IPC training and decision on service resumption.
• Most outreach activities postponed due to a COVID-19 community outbreak.
• All entertainment venues and hotspots were closed and KPs have stayed home or found another
job.
• Outreach workers cannot meet or provide education face-to-face, do HIV testing, or accompany
the reactive cases to VCCT and enroll in ART.
• KPs cannot access HIV testing while lockdown is in place and no confirmatory testing can be done,
except at NCHADS and only five per day.
• Outreach workers provide education and make referrals via social media and phone with many
clients LTFU.
EpiC Cambodia Semi-Annual Report (FY21 Q1-Q2 October 2020 to March 2021) 25You can also read
